Comparison of Spirometric Parameters, Symptom Burden and Rehabilitation Implications in Current and Former Smokers with Chronic Obstructive Pulmonary Disease
TL;DR
Multidimensional assessment combining spirometry, CAT, mMRC, smoking exposure history, comorbidity screening, and individualized pulmonary rehabilitation is essential in COPD management.
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive, preventable, and treatable respiratory disease strongly associated with tobacco exposure. Because its clinical expression is heterogeneous, rehabilitation planning requires assessment beyond spirometry. Methods and materials: This retrospective observational study included 767 patients with COPD evaluated between October 2014 and January 2021 in the Pneumology Department of the "Victor Babes" Infectious Diseases Hospital, Timisoara, Romania. Patients were divided according to smoking status into current smokers (n=337) and former smokers (n=430). COPD diagnosis was based on specialist clinical assessment and spirometric evidence of airflow obstruction; post-bronchodilator FEV1/FVC (reported as BPI in the database) 0.70 was used as the reference criterion according to GOLD recommendations. Demographic data, body mass index, spirometric parameters, CAT, mMRC, exacerbations, and comorbidities were analysed. Results: The cohort included 593 men and 174 women, aged 37-92 years. Mean age was 63.5 ± 9.5 years and mean BMI was 28.6 ± 6.7 kg/m2. Mean forced vital capacity (FVC) was 2.78 ± 1.02 L, mean forced expiratory volume in one second (FEV1) was 1.69 ± 0.72 L, and mean FEV1% was 58.87 ± 20.57%. Current smokers had slightly higher mean FVC and FEV1 values than former smokers, without statistically significant spirometric differences. Former smokers reported higher CAT scores (24.8 ± 6.9 vs. 23.1 ± 7.0; p 0.001) and mMRC scores (2.79 ± 0.66 vs. 2.63 ± 0.67; p 0.001), indicating a greater symptom burden. Arterial hypertension was the most frequent comorbidity (n=514), followed by heart failure (n=147), diabetes mellitus (n=120), and pulmonary neoplasm (n=62). Exacerbations were present in 404 patients (53%). Conclusion: In this cohort, smoking status was associated with small spirometric differences, whereas former smokers reported greater symptom burden. Multidimensional assessment combining spirometry, CAT, mMRC, smoking exposure history, comorbidity screening, and individualized pulmonary rehabilitation is essential in COPD management.